Category Archives: Group therapy

Post-Partum (now Peripartum) Depression: What you should know . . . and some resources to help you know it

Note: This post is provided for individuals interested in learning more about post-partum or peripartum depression. It’s also a supplement for the recent Practically Perfect Parenting Podcast on “Post-Partum Depression.” You can listen to the podcast on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting/id1170841304?mt=2

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For the first time ever on planet Earth, the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes the diagnosis of Peripartum Depression. Although I’m not usually a fan of labeling or big psychiatry, this is generally good news.

So, why is Peripartum Depression good news?

The truth is that many pregnant women and new moms experience depressive symptoms related to pregnancy and childbirth. These symptoms are beyond the normal and transient “baby blues.” Depressive symptoms can be anywhere from mild to severe and, combined with the rigors of pregnancy, childbirth, and parenting a newborn, these symptoms become very difficult to shake.

But the most important point is that Peripartum Depression is a problem that has been flying under the RADAR for a very long time.

Approximately 20% of pregnant women struggle with depressive symptoms. The official 12-15% estimates of post-partum (after birth) depression in women are thought to be an underestimate. What makes these numbers even worse is the fact that society views childbirth as a dramatically positive life event. This makes it all-the-more difficult for most pregnant women and new moms to speak openly about their emotional pain and misery. And, as you probably know, when people feel they shouldn’t talk about their emotional pain, it makes getting the help they deserve and recovering from depression even more difficult.

Jane Honikman, a post-partum depression survivor and founder of Postpartum Support International has three universal messages for all couples and families. She says:

  • You’re not alone
  • It’s not your fault
  • You will be well

Keep in mind that although peripartum depression is thought to have strong biological roots, the first-line treatment of choice is psychotherapy. This is because many new moms are reluctant to take antidepressant medications, but also because psychotherapy is effective in directly addressing the social and contextual factors, as well as the physiological symptoms. Additionally, as Ms. Honikman emphasizes, support groups for post-partum depression can be transformative.

Below, I’m including links and resources related to peripartum or post-partum depression.

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A very helpful informational post by Dr. Nicola Gray: http://cognitive-psychiatry.com/peripartum-depression/

Books by Jane Honikman can be found at this Amazon link. Her books include: I’m Listening: A Guide to Supporting Postpartum Families.  https://www.amazon.com/s/ref=dp_byline_sr_book_1?ie=UTF8&text=Jane+I.+Honikman&search-alias=books&field-author=Jane+I.+Honikman&sort=relevancerank

Although it’s true that peripartum depression can be debilitating, it’s also true that it can be a source of personal growth. Dr. Walker Karraa shares optimistic stories of post-partum related trauma and growth in her book:

https://www.amazon.com/Walker-Karraa/e/B00QTWH9PW/ref=dp_byline_cont_book_1

 

The Love Reframe

 

Years ago I had the privilege and challenge of teaching a class for divorced parents through Families First in Missoula. About half of the dozen or so participants were mandated to attend. This made for an initially less-than-pleasant opening mood. As I went around the room doing introductions, I came to a man who looked a bit snarly. He announced his name and then said, “But I don’t need no stupid-ass parenting class. The only reason I’m here is because the Judge told me that if I didn’t come, I’d be forced to have supervised visits with my 12 year-old daughter. I’m here, but I don’t need this stupid-ass class.”

 

This was a difficult moment and perhaps because I’m a man, complete with a pesky “Y” chromosome, I was tempted to get into an instant pissing match right there. I felt an urge to say something like, “Well, you may not think you need this class, but apparently the Judge does and so you’d better watch how you talk in here!” Instead, somewhat to my surprise, the following words came into my mind and then out of my mouth, “Well, let me especially thank you for coming because you must really love your daughter to be willing to attend this class.”

 

As the 6 hour marathon class progressed, the snarly man settled in. He was never really pleasant, but he contributed to discussions and politely got in line at the end of class to receive his signed certificate. When I handed him the certificate, I said something like, “Hey, you know you should frame this certificate and put it on your wall at home.”

 

A few weeks after the class I got a call from the guy who didn’t need a stupid-ass parenting class. He sounded different and immediately apologized for “being a jerk in class.” Then he told me in a cracking voice that he’d taken my advice and hung the class certificate on his wall. And then it was clear he was crying when he said, “My daughter came over for an unsupervised visit and when she saw that certificate on the wall, she turned around and gave me this big old hug and said, Daddy, I am so proud of you!”

 

This experience and others like it taught me an important lesson about parents in general and fathers in particular. I’ve learned that underneath the bluster of some irritable and difficult dads there are men who desperately love their children. If we tap this potential, good things can happen.

When Giving Gives Back

For several years Rita has been having first year counseling students do at least five hours of “volunteer” work with our local day treatment center for clients (or consumers) who struggle with chronic mental disorders. This year Rita is on sabbatical and so the task fell to me. To be honest, I was ambivalent about the assignment, mostly because the logistics seemed challenging. I had to arrange two separate organizational visits to the mental health center for about 15 students with different schedules before the volunteering could start and I struggled to make these happen in a timely manner. I secretly wondered if arranging this experience would be worth the hassle.

On Monday, October 29, I finally met the first group at the Day Treatment program and was emotionally transported back to the early 1980s when I was worked in a Day Treatment program and then as a recreation therapist at a 23-bed private psychiatric hospital. I listened as a staff member gave us the most unstructured orientation ever. He eventually told us that he was a “client” at the center before becoming staff. He told the students they were free to just drop in and hang out whenever. I could feel the students’ anxiety rising at the thought of just hanging out and so I asked a few questions and told a couple stories to take up time and they asked questions of their own. In an odd mix of awkwardness and genuineness and anxiety, I felt the wish to just hang out with the day treatment clients myself.   

But instead of hanging out, the reality of other responsibilities started pressing forward and I left with unresolved emotions. I decided to deal with those emotions by writing a small check to support the River House Day Treatment Member Fund. I wrote the check and sent it off.

After completing their five volunteer hours, our students are required to write a short essay about their experience. Today, I’ve spent much of my day reading these essays. They are amazingly open and appreciative of the experience. Some samples:

“I am always humbled by the willingness of others to not only be open with me and to share with me their experiences but also by the ‘sameness’ of a lot of human experiences and suffering.”

“It felt good to share in the humanness of it all- bad days, favorite things, boyfriends, girlfriends, family, and trying to find meaning even when our stories are so different.”

“The clients were not only positive and loving toward the staff members, but also towards me as a volunteer. Every client I was able to talk to complimented something about me and they were constantly complimenting each other.”

“The clients I talked with accepted me in to their community and openly shared their experiences with me. This allowed me to see the world, in a small way, through their eyes.”

Every essay has emphasized the positive environment, the loving-kindness of staff and patients, and the surprise and joy of making deeply human connections. I also received an excellent formal thank-you note from the program director (for the small donation). In it she enclosed a short note from the clients or members of the Day Treatment Center. They wrote:

Thank you so much for the monetary gift. We appreciate it so much. Your students have blessed us with their presence and we have enjoyed them. I hope that we can give the students a fresh perspective on how a special place such as River House can do good and help its members. I hope you will always feel welcome here and thank you for all you do, mentoring the students and giving gifts to us.

This letter and the feelings I get when I read “Your students have blessed us with their presence . . .” was much bigger than what I gave. That’s the same message I keep getting from my students. They went with minimal expectations, a little angst, and to clock their required hours. But instead of just completing a simple assignment, they received an experience so meaningful that many of them have are extending their volunteer work far beyond the required five hours.

This is a fabulous example of how giving can give back much more than what was originally given. This is probably what Adler meant by Gemeinschaftsguful.

Thank-you to the River House staff and members for . . . BLESSING US with YOUR presence.

My Favorite Imaginary Group Therapy Session

This is an excerpt from our soon-to-be-published Counseling and Psychotherapy Theories in Context and Practice (second edition, 2012, John Wiley & Sons). It is, of course, like most theories textbooks, packed with subtle and less subtle humor. We even recently had a senior in college tell us that it was the first textbook he actually read cover-to-cover. Now if that’s not an endorsement of just how riveting a textbook can be . . .

The following excerpt is from the last chapter (Chapter 14).

A Concluding Image: Group Therapy with Some Amazing Clients

After reading and writing about so many great therapy minds, one of us (you can guess which one) had the following daydream: Imagine many of the historical and contemporary therapy masters gathered together in one location. They form a circle and begin a discussion. Old friends and rivals are reunited. Freud appears and shakes hands with Jean Baker, Miller who has brought quite a number of impressive-looking women with her. Fritz Perls tries to kiss some of their hands. Adler brings his wife. Carl Rogers signs a book for Prochaska. New friends are made, old rivalries rejuvenated. Insoo Kim Berg smiles quietly off to one side. Jung notes to himself that she must be an introvert. What might happen in this circumstance? What might happen in An Encounter Group for the Major Players?

After some initial mingling, the group process begins:

Rogers: I wonder where we might want to start.

Raissa Adler: Here’s where I’m starting. I’m not taking the minutes for this meeting. I did that back in 1912 for the Free Psychoanalytic Society, so I’ve put in my time. It’s someone else’s turn, and I nominate a male, any male. Women have been taking notes in meetings for so long it’s ridiculous. The problem with women’s psyches has more to do with oppression than repression.

Feminists: [Including Jean Baker Miller, Judith Jordan, Espin, Lillian Comas-Diaz, and Laura Brown—all of whom subversively snuck into the group] You go woman! We’re with you.

Freud: That’s it. Say whatever comes to mind.

Ellis: If you want to think that taking notes is oppression, that’s up to you, but as far as I can tell, you’re oppressing yourself with a bunch of damn crazy, irrational thinking.

Beck: You know Al, we’ve been through this before, but what I think you mean is that Raissa’s thinking that taking notes is oppression could be maladaptive, but not irrational.

Glasser: Raissa can choose to take notes or choose not to take notes. She can also choose to think she’s oppressed or choose not to think she’s oppressed. Personally, Raissa, I recommend that you read my book, Choice Theory. I want you to read it, and I think it will help you, but of course, whether you read it or not, that’s completely your choice.

F. Perls: Be here now, Raissa. Act out those feelings. Be the pen. Talk to the paper.

L. Perls: Fritz, she can be the pen without your assistance. If by chance she finds herself, that’s beautiful.

Ellis: She won’t find a goddamn thing in this group of love-slobs without a flashlight.

Skinner: Uh. Albert. I’ve been wanting to mention to you that if you could just keep quiet when people in here say inappropriate things, we might have a chance at extinguishing that particular behavior.

Ellis: Well, Burris, did you have an irrational thought that someone might actually care about your opinion before you engaged in that speaking behavior, or was it just a function of its consequences?

V. Satir: Albert, if you could just get up on that chair and talk down to Burris, I think you could get in touch with your placating style.

Skinner (Whispering to Ellis): Seriously man. Just ignore her. I’m talking about a complete extinction schedule. Just like I’m ignoring you – except for when you sit quietly and listen to me like you’re doing now.

Rollo May: Freedom and dignity are the essence of being. There’s far too much freedom, with very little dignity in this room.

I. K. Berg: If a miracle happened and we all got out of this group without anyone getting murdered, what would that look like?

A. Adler: My God, I just remembered an earlier memory. No wonder I felt so inferior.

Freud: I hate that word. I just want to be recognized for my contributions. It would make my mother proud.

Rogers: It’s like if only I can make my mother happy. And getting recognized, being remembered, that’s one big way you can have that experience.

Ellis: Siggy, my man. Let me just say this. That crap about being recognized and making your mother proud is the most f—ing ridiculous thing I’ve ever heard in my life. What’s the big deal if everybody forgets you? What’s the terrible, awful, very bad thing that will happen? I mean, think logically about this. You’ll be dead and it won’t make a white rat’s ass difference if people remember you or not.

Feminists: That’s right. I can’t believe we’re agreeing with Albert Ellis. White males can afford to play with such big ideas. Immortality. Do you have a clue about the legacy you’ve actually left? There have been decades of girls and women with destroyed self-esteems. Do you recognize that they litter your road to “greatness”?

Mahoney: I can see Freud as great and I can see feminism as great. Even this lived moment in our genetic epistemology exudes the potential for greatness. We are not a passive repository of sensory experience, but instead, we’re co-constructing this reality right now.

Prochaska: This entire group seems to me to be in precontemplation.

D. W. Sue: Yeah, well, I might consider change if we could construct in a minority voice or two? Most of what I’ve heard thus far is the construction of a very narrow, White reality. Culture is primary, and we need to include color if we’re to meet the needs of everyone, including Raissa, who happens to have a strong Russian ethnocultural identity.

Raissa Adler: [Slowly stands and walks over and embraces D. W. Sue.]

Rogers: What I’m seeing and what I’m hearing, if I’m getting this right, is affection and appreciation. Two people who have, now and again, felt marginalized are able to connect more deeply with each other right now in this moment than with anyone else.

M. White: Actually, Carl, I think I’d just call this a sparkling moment.